key: cord-278873-x6i5tiju authors: Reddy, Vidhatha; Kollhoff, Alexander L; Murase, Jenny E; Martires, Kathryn title: Management guidelines for pregnant healthcare workers exposed to infectious dermatoses date: 2020-04-18 journal: Int J Womens Dermatol DOI: 10.1016/j.ijwd.2020.04.004 sha: doc_id: 278873 cord_uid: x6i5tiju Exanthematous diseases are frequently of infectious origin, posing risks, especially for pregnant healthcare workers (HCWs) who treat them. The shift from cell-mediated (Th1 cytokine profile) to humoral (Th2 cytokine profile) immunity during pregnancy can influence the mother’s susceptibility to infection and lead to complications for both mother and fetus. The potential for vertical transmission must be considered when evaluating the risks for pregnant HCWs treating infected patients, as fetal infection can often have devastating consequences. Given the high proportion of women of childbearing age among HCWs, the pregnancy-related risks of infectious exposure are an important topic in both patient care and occupational health. Contagious patients with cutaneous manifestations often present to dermatology or pediatric clinics, where female providers are particularly prevalent, as a growing number of these physicians are female. Unfortunately, the risks of infection for pregnant HCWs are not well defined. To our knowledge, there is limited guidance on safe practices for pregnant HCWs who encounter infectious dermatologic diseases. In this article, we review several infectious exanthems, their transmissibility to pregnant women, the likelihood of vertical transmission, and the potential consequences of infection for the mother and the fetus. Additionally, we discuss recommendations with respect to avoidance, contact and respiratory precautions, and the need for treatment following exposure. HCWs. This review identifies various infectious exanthems that pregnant HCWs may be exposed 30 to and summarizes current available evidence regarding risk of transmission. Specifically, we 31 discuss parvovirus B19, hand, foot and mouth disease, mycoplasma-induced rash and mucositis, 32 measles, herpes simplex virus, varicella-zoster virus, and pityriasis rosea. We also provide 33 guidelines for each disease in order for pregnant HCWs and HCWs of reproductive potential to 34 appropriately minimize risk and pursue work-up and treatment, if necessary, following exposure. 35 Finally, given the ongoing global coronavirus disease 2019 (COVID-19) pandemic caused by 36 SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), we also summarize available 37 safety guidelines for pregnant HCWs who are working during this time. 59 Data on the risk of transmission to HCWs, however, is conflicting (Adler et al., 1993) . following exposure to infected patients. One single-center study at Children's Hospital of 63 Philadelphia found elevated risk of infection between exposed and unexposed staff (Bell et al., 64 1998 ). However, a cohort study of 87 HCWs exposed to two patients with parvovirus B19-65 induced aplastic crisis found no significant increase in parvovirus B19-specific immunoglobulin 66 M (IgM) and immunoglobulin G (IgG) antibodies when compared with unexposed health care 67 workers in the same facility (Ray et al., 1997) . While the risk of transmission to HCWs has not been definitively identified, preventing 69 the transmission of PVB19 infection is important as it can lead to adverse pregnancy outcomes. PVB19 infection carries a 9% excess risk of miscarriage within the first 20 weeks of gestation, 71 and 2.9% risk of fetal hydrops between weeks 9 and 20 (Miller et al., 1998 vesicular rash affecting the hands, feet, and oral mucosa. As one of the most common pediatric 91 exanthems, HFMD is routinely seen by pediatric and dermatology HCWs, presenting a potential 92 concern for occupational exposure. All HCWs who are exposed to VZV should be monitored daily during days 8-21 after The etiology of PR is unclear. Various clinical and epidemiological features of PR 318 support a viral origin, including its self-limiting course, low recurrence rate, occasional 319 household clustering, possible seasonal variation, prodromal symptoms, response to acyclovir, 320 and higher prevalence during states of impaired immunity (e.g., pregnancy). There is a well-321 established association between PR and human herpesviruses 6 and 7 (HHV-6/7) (Drago et al., Since PR is self-limiting, management is generally limited to reassurance and the 360 treatment of symptoms with emollients, antihistamines, and occasionally topical steroids. when caring for patients with PR. Although PR is not thought to be contagious, and women of 374 childbearing age have likely already been exposed to HHV-6/7, this recommendation is based 375 upon the uncertainty surrounding its etiology and the potential danger of infection to the fetus. Both pregnant HCWs and patients have expressed concern regarding potential complications 387 from COVID-19, although the disease appears to disproportionately affect men compared to The CDC's recommendations for the vaccination of HCWs are summarized in Table 3 . 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